12-hour Shifts

In more than eight years as a labor and delivery nurse, Hallie Shafer, RN, BSN, always has worked 12-hour shifts. The 31-year-old Shafer, who works on the special delivery unit at The Children’s Hospital of Philadelphia, can’t imagine working any other shift.

“I think that it’s great for both work and your outside life,” Shafer says. “At work, you can have the continuity of care with the patients. You’re with them for a full 12 hours.”

Away from work, Shafer is grateful for the flexibility the shifts afford her. “I seriously don’t understand how other professionals get to doctor’s appointments or dentist appointments or do other things in their lives,” says Shafer, who grew up in Oregon and moved within the past year to the Philadelphia area. “One thing I appreciate about it is just the fact that I’m able to travel. My family is still all on the West Coast.”

Rather than use vacation time, Shafer says she occasionally “will schedule three [12-hour shifts] at the beginning of a week and three at the end of the following week for a stretch of time off so that I can get back to see my family and friends.”

Although nurses across the country delight in the benefits of 12-hour shifts, concern is growing about the risks to RNs, including health issues later in life, and the potential danger for patients as well.

Hello 12 Hours, Goodbye Sleep?

As a researcher for projects funded by the National Institutes of Health and the U.S. Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health, Jeanne M. Geiger-Brown, APRN-BC, PhD, can’t help but worry about nurses.

“I know this sounds sort of radical, but I believe that by doing the 12-hour shifts, we’ve [sent] a whole generation of nurses into poor health in later years,” says Geiger-Brown, an assistant professor at the University of Maryland School of Nursing, Baltimore. “But because [nurses] like them so much, I don’t think that they’re likely to change until, frankly, they get older.”

Geiger-Brown says the 12-hour shift came about to retain staff during a national nursing shortage in the 1970s. Nurses wanted more time at home, which the 12-hour shift allowed. “Staff nurses were really the impetus for change [to] this 12-hour shift solution,” Geiger-Brown says. The shifts also allowed hospitals to use fewer agency nurses, she says.

Geiger-Brown served as principal investigator for the “Nurses’ Sleep Study,” which yielded the three-part series of articles “Is It Time to Pull the Plug on 12-Hour Shifts?” She coauthored the series, which ran last year in the Journal of Nursing Administration, with Maryland SON colleague Alison M. Trinkoff, RN, ScD, FAAN, professor.

Geiger-Brown studied 80 female full-time RNs working three consecutive 12-hour shifts, both night and day, which were preceded by two days off. The study revealed a pattern of sleep deprivation and slower reaction times.

Even before the first of their three shifts, 25% of nurses slept less than six hours. Using an actigraph, a device worn like a wristwatch that measures activity and sleep, Geiger-Brown says one of the nurses studied averaged 2.7 hours of sleep between shifts. After the first 12-hour shift, nurses in Geiger-Brown’s study averaged 5.4 hours of sleep, with night nurses sleeping 5.2 hours.

A night-shift nurse, meanwhile, reported that her best opportunity to sleep was when her young child slept during the day, “and he didn’t take a nap today.”

Using the Karolinska Sleepiness Scale with nurses recording sleepiness in a range from one (wide awake) to nine (fighting sleep), Geiger-Brown recorded 17.5% of night nurses had a score of eight or nine during at least one of their three shifts.

While attempting to combat a lack of sleep, one nurse drank 160 ounces of caffeinated drinks in a 24-hour period.

Geiger-Brown says studies by other researchers connect sleep deprivation and longer work shifts to a rise in medical errors; drowsy driving; and neck, back and shoulder injuries.

“Some of these nurses have worked 12-hour shifts for 30 years,” Geiger-Brown says. “This is basically a lifetime of partial sleep deprivation.”

That lack of sleep can raise short-term issues such as attention failures, impaired mood and loss of sense of humor, Geiger-Brown says. In the long term, greater risks for obesity, heart disease, stroke, hypertension, glucose regulation, GI disorders and reproductive problems also are cause for concern, she says.

12 Hours, Then and Now

Mary Ann Faralli, RN, EdD, MSN, MBA, CCRN, nurse manager of the ICU and IMC at Bayhealth Medical Center’s Milford (Del.) Memorial Hospital, has been on both sides of the 12-hour shift debate during her 26-year career.

As a staff nurse in the 1990s at one Philadelphia hospital, she worked as many as six 12-hour night shifts in a row. “I was in my mid-20s, and it didn’t even faze me,” Faralli says. “I never felt that I wasn’t able to make decisions with my patients.”

When she got married and started a family, Faralli was working in nursing administration, but made an unusual career change. “I actually switched back to being a staff nurse [working 12-hour shifts] when I had kids because it fit better in my life,” Faralli says.

Although Faralli says she does not have health problems from her past work schedule, she does not recommend it to her staff today. “If I call a nurse up and they can’t come in, I say, ‘Well, thank you very much. Maybe next time you can help us out.’ I can see that they’re exhausted,” she says. “Patients are sicker today, and there’s more responsibility on the RN.”

Respite and Responsible Scheduling

When Chicago’s Rush University Medical Center began planning its 14-story addition, an idea stuck with Eileen Dwyer, RN, MS, a director in Rush’s Office of Transformation, and her colleagues. When the building officially opens in January 2012, many of the floors will include a respite room for nurses and other staff members to take a break.

“It’s away from the activity, yet not that far away because nurses won’t go that far from their work area,” Dwyer says.

Geiger-Brown says nurses and administrators should share the responsibility of making schedules work. “I was really struck by the fact [during the study] that there are some units that always leave on time, and they always take breaks and they take breaks off the unit,” Geiger-Brown says. “And there are other units where that never happens. I think that’s a place where management can make a difference by changing the culture.”

For Nurses:• Leave work on time• Take breaks away from the unit• Do not accept overtime nor on-call, nor take a second job• Take 20-minute naps, especially on the night shift

For Administrators:• Provide shiftwork education during orientation• Screen nurses for sleep disorders• Modify lighting at nurses stations and provide blue-blocker sunglasses for driving• Adopt fatigue-risk-management software developed by other industries, such as trucking and aviation